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Health Care Decisionmaking

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Family attitudes and patient wishes, not timing of the request, usually determine consent for organ donation

When a loved one is dying from an irreversible neurological brain injury, family members weigh a number of factors in deciding whether to donate their loved one's organs. Timing of the organ donation request from health professionals makes little difference. Rather, active consideration of the patient's donation wishes and a clear understanding of the family's initial inclination toward donation are strongly associated with organ donation consent, according to findings from a large national study supported in part by the Agency for Healthcare Research and Quality (HS08209).

Laura A. Siminoff, Ph.D., and colleagues at Case Western Reserve University School of Medicine used data from a study of 420 organ donor-eligible patients and their families from nine trauma hospitals to examine factors affecting families' decisions about organ donation at the time of a family member's death. They conducted in-depth interviews with family members, health professionals, and organ procurement organization staff involved in the process.

Some previous studies have suggested that asking families about organ donation after their loved one has died (often referred to as "decoupling"), instead of before or at the time of death, would increase consent for organ donation. However, Dr. Siminoff and colleagues found only a weak effect for timing on the donation decision and not the one generally reported. Families donated most frequently when donation was raised prior to declaration of death (near determination of brain death), followed by after the declaration of death.

A family was more likely to consent to organ donation if the donor patient was younger, the family had stronger positive attitudes about donation, and the family felt that they had enough information about the patient's wishes. Donation was also associated with the health care professional understanding the family's initial response (favorable, unsure, or not favorable) to the request for organ donation.

More details are in "Decoupling: What is it and does it really help increase consent to organ donation?" by Dr. Siminoff, Renee H. Lawrence, Ph.D., and Amy Zhang, Ph.D., in the March 2002 Progress in Transplantation 12(1), pp. 52-60.

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